THIS IS A NEW ACTIVITY.

1. ACTIVITY DESCRIPTION

APHIA II NEP will support facilities to provide a comprehensive antenatal package for all pregnant women

including screening, prevention and treatment for any infections (such as sexually transmitted infections and

malaria), nutrition support, prophylactic ARVs, counseling on safe infant feeding, counseling and HIV testing

of women and their partners. APHIA II NEP will support established support groups that are formed around

PMTCT sites by mothers who have benefited from the project services. In addition referral linkages will be

established within facilities where APHIA II NEP is providing antiretroviral therapy, through which HIV

positive clients are assessed and put on treatment where necessary. The number of HIV positive women

and children on treatment is expected to increase steadily through these networks. Laboratory networks will

also be established that will greatly improve ART uptake as well as early infant diagnosis. In 2008 APHIA II

NEP will provide HIV counseling and testing to 29,407 pregnant women and provide antiretroviral

prophylaxis to 879 HIV-positive women. Of these 440 will receive AZT, 264 will receive single dose

nevirapine and 175 will recive HAART. 440 exposed infants will receive PCR for early infant diagnosis. At

the community level lay counselors will be trained to strengthen the delivery of PMTCT services and to

provide continued support for the HIV-positive women and their families. The project will train community

health workers to provide community components of PMTCT services. In order to improve the quality of

care, 50 health supervisors will learn management skills, including utilization of data for decision making. In

2008, this project will strengthen District Health Management Teams (particularly in 8 new newly formed

districts), and referral networks for PMTCT-plus activities. The project will train 120 health workers in 60

sites in PMTCT and comprehensive HIV management for HIV-positive mothers and their families. Efforts

will be made to increase early infant diagnosis in order to identify infants that require HIV care and

treatment and offer more appropriate advice on infant feeding choices. More efficacious regimens for

PMTCT will be introduced and scaled up in all the sites offering services. Linkages to FP/RH will be made

as well as to laboratory services in order to offer a more comprehensive package of care.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute CT to 2.5% of the overall 2008 Emergency Plan PMTCT targets for Kenya.

Community participation and male involvement will significantly contribute to PEPFAR goals for primary

prevention, access to care and treatment, and support of those affected and infected. Technical assistance

to the Ministry of health facilities will contribute to improvement of the quality of services.

3. LINKS TO OTHER ACTIVITIES

Linkages to HIV care and treatment services will be strengthened, to ensure immediate appropriate care for

the woman and exposed infants, as well as other family members, thus optimizing utilization of

complementary services created through Emergency Plan funding. This activity will relate to the ARV

services, OVC care, TB/HIV services, HBHC and STP services funded under the APHIA II NEP.

4. POPULATIONS BEING TARGETED

This activity targets adults, pregnant women, HIV+ pregnant women, HIV affected families, and HIV+ infants

with service provision. Health care providers including doctors, nurses and other health care workers will be

targeted for training on PMTCT using the national NASCOP PMTCT CDC/WHO based curriculum.

5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at

antenatal clinics and maternity units. Community Health workers will conduct community mobilization

activities that will help increase service uptake as well as address issues of stigma and discrimination at

community level. This is also hoped to help address male norms and behaviors as well as reduce violence

and coercion against women. This activity includes emphasis on human capacity development through

training and supportive supervision. Attention will also be paid to Quality Assurance, Community

Mobilization/Participation and Development of Network/Linkages/Referral Systems. Data collection and

utilization is paramount to successful program implementation and support will be given to strategic

information. Linkages to safe motherhood will be created to improve outcome of interventions in that hard to

reach population.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP are:

• Prime partner Pathfinder International has been competitively selected to implement the activity;

• The target population has been revised to include teachers who, in collaboration with the Ministry of

Education and other stakeholders, at approximately $30,000 plus funding from OP and OHPS totaling

$150,000, 750 teachers will be sensitized about HIV/AIDS prevention and the AIDS policy for the education

sector;

• The KARHP methodology will be rolled out in collaboration with the Ministry of Education, Ministry of

Health and Ministry of Gender, Sports, Culture and Social Services;

• Peer education activities will be rolled out with the Kenya Girl Guides Association;

• AB funds totaling $23,000 will contribute to the sensitization of teachers as a worksite population linking

with additional OP and OHPS funds for a $150,000 activity to reach 750 teachers and train 20 more

1. LIST OF RELATED ACTIVITES

This activity relates to activities in Other Prevention (#xxxx), Counseling and Testing (#8778), Palliative

Care: TB/HIV (#9066), and Prevention of Mother-to-Child Transmission (#7087).

2. ACTIVITY DESCRIPTION

Kenya's North Eastern Province (NEP) is fortunate to have much lower HIV prevalence rates than other

provinces in the country. The KDHS shows rates varying from 0-2% across the province. The primary focus

of APHIA II NEP will be to maintain low prevalence rates through reinforcing the attitudes of local religious

and societal leaders around abstinence and being faithful and using them as culturally acceptable means

for influencing the local population. However, PMTCT data from UNICEF's work in the region shows areas

of rapid expansion of the epidemic mainly around Garissa (5%) and other urban centers which are acting as

catalysts in fueling the spread of the HIV epidemic. Urban areas within NEP generally feature significant

populations of civil servants, uniformed services personnel and commercial traders, most of whom are from

other regions of the country and are living in isolated areas unaccompanied by their spouses or families.

Despite the general perception of NEP as an Islamic province with conservative social morals, these urban

centers feature "hot spots" for commercial sex and opportunities for the AIDS virus to enter the mainstream

population through sex with widows and polygamous unions. In FY 2008, APHIA II NEP will target youth

and adults with AB messages that are appropriately segmented to different target groups and are culturally

sensitive. Islamic leaders in NEP are in full support of promoting abstinence and being faithful and will be

important channels for communicating these messages, as well as addressing issues around stigma and

VCT. Emphasis will be on delayed sexual debut, and secondary abstinence will be encouraged for those

youth who are already sexually active. Two local radio stations which broadcast in the Somali vernacular

and have wide audiences within NEP will be utilized for broadcasting public service announcements and

dramas. Existing outreach programs reaching more isolated populations offer an excellent opportunity for

building in culturally appropriate behavior change communication on abstinence and being faithful. APHIA II

NEP anticipates utilizing PLWHAs from the province as spokespersons for raising awareness and

decreasing stigma.

It is expected that 120,000 individuals will be reached by 9,000 trainers with culturally appropriate

messages that promote abstinence and/or being faithful. In conjunction with the OP and OHPS activities,

750 teachers will be targeted as a worksite population who will be sensitized to the AIDS policy for the

education sector and receive instruction on HIV/AIDS prevention. Of these, 20 teachers will be trained as

trainers to roll out the program.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute significantly to the overall 2008 Emergency Plan Prevention/AB targets for

Kenya. Integrating prevention into all community outreach for treatment and care, with special emphasis on

men and youth, will significantly contribute to PEPFAR goals for primary prevention. Prevention messages

will also be given to those who are HIV+ in CT and ART sites.

4. LINKS TO OTHER ACTIVITIES

Support to AB will be one component of a package of integrated support at health facility and community

levels in the region, holistically addressing HIV prevention, treatment and care. This activity relates to

activities in Counseling and Testing (#8778), TB/HIV (#9066), and PMTCT (#7087).

5. POPULATIONS BEING TARGETED

This activity targets both in- and out-of-school youth for abstinence and both adults and youth for being

faithful. Special emphasis will be placed on reaching men through outreach by PLWA and involvement of

community and religious leaders, by couples' counseling in PMTCT and through worksite interventions.

Counterparts from NGOs, CBOs, FBOs and schools will be targeted for training to implement prevention

programs.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address culturally sensitive issues surrounding gender, including male norms and

behaviors. They will also address stigma and discrimination which are quite high in marginalized areas such

as this one where AIDS information is limited.

7. EMPHASIS AREAS

This activity includes a major emphasis on capacity building of implementing partners, community resource

persons (CORPS) and other community level implementing partners. Community involvement in the design

and implementation of activities will play an integral part in ensuring the success of this result area. They

will train the target groups in IEC and develop networks and referral systems.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP are:

+ prime partner Pathfinder International has been competitively selected to implement the activity

+ $100,000 of this allocation will be used to carry out formative evaluation to determine the drivers of the

epidemic in "hot spots' of North Eastern province

1. LIST OF RELATED ACTIVITIES

This activity links with other activities in Abstinence and Be Faithful Programs (#9074), Counseling and

Testing (#8778), Prevention of Mother-to-Child Transmission (#7087) and Palliative Care: TB/HIV (#9066).

2. ACTIVITY DESCRIPTION

$100,000 of this allocation will be used to carry out formative evaluation to determine the drivers of the

epidemic in "hot spots' of North Eastern province. In FY 08, this activity will reach 7,000 individuals with

other prevention interventions and train 60 people. In addition condoms will be distributed through 20

outlets. Kenya's NEP is fortunate to have much lower HIV prevalence rates than other provinces in the

country. The KDHS shows rates varying from 0-2% across the province. The primary focus of APHIA II NEP

will be to maintain low prevalence rates through reinforcing the attitudes of local religious and societal

leaders around abstinence and being faithful and using them as culturally acceptable means for influencing

the local population. However, PMTCT data from UNICEF's work in the region shows areas of rapid

expansion of the epidemic mainly around Garissa (5%) and other urban centers which are acting as

catalysts in fueling the spread of the HIV epidemic. Urban areas within NEP generally feature significant

populations of civil servants, uniformed services personnel and commercial traders, most of whom are from

other regions of the country and are living in isolated NEP unaccompanied by their spouses or families.

Despite the general perception of NEP as an Islamic province with conservative social morals, these urban

centers feature "hot spots" for commercial sex and opportunities for the HIV virus to enter the mainstream

population through widows and polygamous unions. Condom use as an HIV/AIDS prevention strategy is an

extremely sensitive issue among the Muslim community in NEP and must be approached carefully. APHIA

II NEP will carefully target segmented components of the NEP population, working primarily with

commercial sex workers; bar owners; long-distance truck drivers; commercial traders and civil servants from

outside the province; and, members of the uniformed services. The project will collaborate with partners

such as the ROADS project and PSI for reaching targeted groups with condoms and will employ proven

approaches such as the Men as Partners program for developing healthier behaviors within the uniformed

services.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

By supporting the CORP/TBAs to ensure use of sterile birth equipment the project shall reduce the risk of

HIV transmission through the use of contaminated tools. Strengthened referral by the CORP/TBA system

for pregnancy and pregnancy related issues will increase the number of pregnant mothers accessing

essential antenatal services including VCT and PMTCT. Increased use of condoms by clients of CSWs will

reduce opportunities for sexual transmission of the virus among high risk groups.

4. LINKS TO OTHER ACTIVITIES

This activity relates to activities in Counseling and Testing (#8778) and Abstinence and be faithful (AB)

activities (#9074). These OP services will be complemented by other ongoing health activities, which

include community and religious outreach programs for awareness creation and behavior change and

prevention among literate and illiterate populations of North Eastern Kenya. The CORP/TBAs shall provide

basic health services, disseminate HIV/AIDS AB messages and mobilize the pastoral community for

HIV/AIDS services including TB (#9066) and PMTCT (#7087).

5. POPULATIONS BEING TARGETED

These activities target special populations particularly the mobile populations of Northern Kenya. OP

information and condoms will be passed to truck drivers who are a risk group as they move from high

HIV/AIDS prevalence zones of Kenya in search of animals for international markets. Appropriate HIV/AIDS

messages will be disseminated through brochures, billboards, fliers and police road signs. In addition,

special populations, particularly commercial sex workers, in the target districts will be equipped with

appropriate information and empowered to use HIV/AIDS preventive methods at all times. Altogether, 6,000

people will be reached.

6. KEY LEGISLATIVE ISSUES ADDRESSED

The key legislative issue addressed is Gender: working with the women in the project districts who will be

empowered to be decision makers on matters of reproductive health and be persuaded to accept the use of

condoms in a polygamous Muslim population. The KDHS 2003 study indicates that knowledge about

condoms, their acceptability and use is very limited in the project districts of North Eastern Kenya. The OP

program will advocate for and promote strategic condom distribution and use while considering religious,

cultural and gender sensitivities.

7. EMPHASIS AREAS

The major emphasis area for this component is development of network/linkages/referral systems

developing strong referrals through their trained TBAs. In addition another major area is Information,

Education and Communication with activities that will enhance HIV/AIDS prevention behavior. Knowledge of

contraceptive methods in general, and about condoms in particular is low. Acceptability and use of condoms

is less prevalent in the project districts. The Supreme Council of Kenya Muslim (SUPKEM) religious leaders

have rejected condom use among Muslim populations in the project area. The argument that condoms

curtail fertility and save lives is pitted against condoms as a symbol of immorality and uncontrolled sexual

activity. The resultant discourse portrays real conflicts faced by Muslims when they have to decide whether

or not to use condoms. The project will hence discover ingenious avenues to promote condom use in the

project districts and increase both demand and supply to groups at risk.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8980), TB/HIV (#9066), ARV Services (# ) and

PMTCT (#7087).

2. ACTIVITY DESCRIPTION

This activity relates to care and support for people and families affected by HIV/AIDS under the APHIA II

North Eastern Project. APHIA II will oversee implementation of both community and facility-based basic

health care and support programs in conjunction with the TB/HIV and antiretroviral therapy programs being

established and expanded in the North Eastern Province of Kenya. These activities will contribute to the

results of expansion of opportunistic infection management and prevention in both clinical and community

settings for HIV-positive patients, strengthened human resource capacity to deliver this care, and a

strengthened referral network for provision of HIV care services in North Eastern Province. Cotrimoxazole

prophylaxis and where indicated, fluconazole prophylaxis will be the basic standard of care for HIV infected

people within the community. APHIA II North Eastern's approach is to build capacity among health care

workers at the Garissa Provincial Hospital and other district hospitals to care for HIV+ adults and children. In

FY 2008 APHIA II will work closely with NASCOP and key stakeholders to design and rollout an effective

HIV care strategy that utilizes the network approach to HIV care and treatment, where the provincial and

district hospitals will be the main HIV care referral centers, and effective referral systems will be established

between community outreach, facility-level and CBO-based programs. Due to the predominantly nomadic

nature of the populations in this region, and the vast distances involved, basic care packages will be

distributed and replenished through outreach campaigns established with local partner agencies and

providing comprehensive health and information services.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Through these programs 1500 HIV-infected individuals will be supported through community outreach,

facility-level and CBO-based programs at 70 facilities.

4. LINKS TO OTHER ACTIVITIES

This activity carries forward previously approved activities in FY 2007 COP by UNICEF. This activity will be

linked to the PMTCT-APHIA II- activity, Palliative Care: TB/HIV and counseling and testing services which

are provided by this and other partners in same region. This will ensure optimum utilization of

complimentary services created through the Emergency Plan and other partners.

5. POPULATIONS BEING TARGETED

This APHIA II activity mainly targets HIV positive adults and children and other persons living with HIV-

AIDS. Health care workers such as doctors, nurses, pharmacists, laboratory workers and clinical officers in

public facilities are also targeted for training. The community activity targets to recruit train and retain

community health workers that will be the link between clinical and community-based services.

6. KEY LEGISLATIVE ISSUES ADDRESSED

The key legislative issue addressed is reducing stigma and discrimination at community and facility level in

order to ensure that people who would not have otherwise gone for treatment are able to do so.

7. EMPHASIS AREAS

This activity puts major emphasis on training of health care workers with minor emphasis on needs

assessment, quality assurance and supportive supervision and development of networks / linkages / referral

systems.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity will be linked to ARV services (#8805), Palliative Care: Basic Health Care and Support

(#8867), and Counseling and Testing (#8778)

2. ACTIVITY DESCRIPTION

There are a number of variables that distinguish NEP from the rest of the county and have important

implications for health programming. First, NEP has the lowest utilization of health services in the country.

This is due to a combination of factors, including poorly staffed facilities; vast distances between facilities;

very high illiteracy rates of both men and women; extraordinary stigma, particularly around the use of

condoms; high rates of TB (though to date this is largely unassociated with HIV) and stigmatization of those

with TB; low rates of HIV prevalence in persons being treated for TB (typically only around 3-4%); religious

and social attitudes and beliefs which discourage the use of health facilities for deliveries; harsh conditions

which contribute to understaffing and poor retention of those who do report for duty. Outreach services,

which are able to respond to the movement of pastoralists, can help to address the inaccessibility of distant

Servive Delivery Points (SDPs); however, the quality of services provided by SDPs must also improve

significantly. While stigma is the major cause for people in NEP not knowing their HIV status, the

availability and quality of counseling and testing services requires significant improvements. Intensified TB

screening for 10000 HIV patients and HIV screening for 700 TB suspects/patients will be offered as a

standard of care in all the facilities; approximately 350 TB patients will be identified as being infected with

both TB and HIV

This activity will build on USAID investment through UNICEF to provide support for strengthening and

expanding palliative care in clinical settings addressing TB and HIV. Emphasis will be on filling gaps in

service delivery and linking to community based services. TB prevention, treatment and care programs will

be strengthened and effective linkages made between TB and HIV services. TB manyattas in each district

will be renovated. Service quality and supervision at all levels of facility care and referral will be improved.

Drug supply management, case management, records systems, supervision and community-based

adherence/follow-up will be strengthened. All health facilities targeted by the project will provide OI

treatment, including TB, cotrimoxazole prophylaxis, and nutritional support. APHIA II NEP will work to

expand diagnostic and DOTS case management capacity, including improving the quality of TB diagnostic

laboratories. It will provide guidance for training of nurses and CHWs, annual refresher training on

TB/HIV/AIDS care and education. It will pilot ART provision in TB clinics in an effort to decentralize and treat

patients where they are presenting for care.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

In NEP and northern parts of Eastern and Rift Valley provinces in FY 2008, 700 people will be provided

with TB treatment servives.

4. LINKS TO OTHER ACTIVITIES

Clinic-based palliative care is one component in a comprehensive treatment and care approach under

APHIA II, such that clients will benefit from long term ART and linkages to community services. Linkages

will also be made with the NLTP and CT, PMTCT and OVC sites.

5. POPULATIONS BEING TARGETED

This activity targets clients at antenatal clinics, VCT sites, in-patients and clients of DTC, TB-ward patients

and clients of home and community support services who are referred for clinical care by community health

workers and Health care.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address stigma and discrimination against persons dually infected with TB and HIV.

7. EMPHASIS AREAS

This activity includes major emphasis on quality assurance, quality improvement and supportive

supervision. Minor emphasis will be placed on training and development of networks/linkages/referral

systems.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity relates to counseling and testing (#8778), ARV Services (#8805) and Palliative Care: basic

health care and support (#8867).

2. ACTIVITY DESCRIPTION

This activity relates to expanded support to be provided to OVC in hard to reach areas. APHIA II NEP will

provide integrated, age-appropriate services to build resilience of children infected with and affected by

HIV/AIDS. Emphasis will be placed on development of healthy and supportive home and community

environments where OVC and guardians/families have access to psychosocial support, education, health

and nutrition services, economic livelihood support, shelter and protection from exploitation and abuse.

Institutional capacity and technical expertise of implementing partners will be strengthened. OVC support

will be integrated with and linked to the project's home and community support. Village Health Committees

and implementing partners will identify OVC, who are often in the same households as those individuals

receiving home-based care and support. It is anticipated that in FY 2008 a total of 5,000 will be reached.

Training of individuals in caring for OVC will cover 500 care givers. Local implementing partners and

community based organizations will be given capacity as appropriate in order provide care and support for

OVC. Caretaker support groups will include OVC needs.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute significantly to the overall FY 2008 Emergency Plan OVC targets for Kenya

ensuring equity in these marginalized, inhospitable and hard to reach areas. Through its OVC activities

APHIA II NEP will address the primary needs of 5,000 OVC and train 500 caregivers.

4. LINKS TO OTHER ACTIVITIES

This activity will be closely linked with other APHIA II North Eastern Province activities in counseling and

testing (#8778), ARV Services (#8805) and Palliative Care: basic health care and support (#8867).

5. POPULATIONS BEING TARGETED

This activity targets orphans and vulnerable children, caregivers, community health workers, teachers,

guardians, educators and volunteers involved with OVC. It also targets community-based and faith-based

organizations in the area.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Issues addressed are stigma and discrimination by developing education for the community about OVC in

an effort to reduce stigma as well as wrap around services for the OVC in the area of food and education.

7. EMPHASIS AREAS

This activity includes major emphasis on child protection through capacity building of local implementing

partners and community health workers (CHWs). Minor emphasis is in the area of community mobilization

and the development of information, education and communication as they relate to the needs of the OVC.

Community involvement in the design and implementation of activities will play an integral part in ensuring

the success of this result area.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in ARV services (#9074), TB/HIV (#9066), palliative care basic health

care (#8867), AB (#9074) and Other prevention (#8937).

2. ACTIVITY DESCRIPTION

In 2008, this activity will VCT services to 10,000 individuals through 10 sites including mobile services and

will train 100 providers in VCT, PITC and HBCT. This activity relates to support to be provided to increase

VCT coverage while taking account of the need to emphasize diagnostic testing and counseling (DTC) as

well. New VCT sites may be needed, for example, in large companies where employees lack easy access.

Mobile VCT will complement fixed sites. Youth friendly services will be emphasized. Where possible, VCT

will be integrated with facility and community level treatment and social support services for individuals

testing positive and with prevention activities for discordant couples and individuals testing negative. DTC

will be scaled up in support of the National AIDS and STI Control Program. Year 1 will see expansion and

strengthening of DTC in imperative site facilities, PMTCT and in district hospitals and health centers with

laboratory capacity. Counselors from targeted facilities will be trained and they will work with GOK and NGO

counterparts to ensure supervision. Individuals who test positive will be systematically referred to CCC and

higher levels for comprehensive testing and linkages to community services. APHIA II NEP TBD will liaise

with NASCOP to ensure HIV test kit supply. It is anticipated that in FY07, 5,000 people will be tested in 5

sites in the Northern Kenya. 30 people will be trained in counseling and testing.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute significantly to the overall 2007 Emergency Plan Counseling & Testing targets for

Kenya. Integrating promotion of VCT into all community outreach for treatment and care will significantly

contribute to PEPFAR goals for primary prevention. This activity will result in 5,000 people tested and

counseled.

4. LINKS TO OTHER ACTIVITIES

Support to counseling and testing will be a linchpin activity in APHIA II NEP TBD resulting in increased

numbers of individuals accessing care, treatment and support and in strengthening prevention efforts. This

activity will specifically be linked to ARV services (#8805), TB/HIV (#9066), palliative care basic health care

(#8867), AB (#9074) and Other prevention (#8937).

5. POPULATIONS BEING TARGETED

This activity targets a wide range of population groups, including, for DTC, those receiving other clinical

services, and for VCT, the general population, with emphasis on sexually active individuals, youth, and high

risk groups such as sex workers, their partners, long distance transport workers and discordant couples.

Health service providers will be targeted for training.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address the GOK VCT policy and guidelines and legislation related to protection of human

rights and confidentiality. It will address gender issues and stigma and discrimination to ensure that women

who are disproportionately affected by HIV are identified and linked with care and treatment programs.

Couples in discordant relationships will also benefit from knowing their status so that they can make

informed decisions in their sexual relationships.

7. EMPHASIS AREAS

This activity includes major emphasis on training to build capacity of Counseling &Testing providers and

Community Health Workers. The activity emphasizes VCT as a major prevention strategy; implementing

Partners, Community Own Resource Persons and other community level implementing partners are key to

its success. Community mobilization and the development of network/linkages/referral systems are all minor

emphasis areas in this activity.

N/A (exempt)

THIS IS AN ONGOING ACTIVITY.

The only changes to the program since approval in the 2007 COP include development of data quality

improvement plan, training data point persons on DQA tools and implementation of regular data quality

audits at sampled health facilities and community level programs. Funding level has also changed. This

activity also includes the development of data quality improvement plan, training data point persons on DQA

tools and implementation of regular data quality audits at sampled health facilities and community level

programs

1.LIST OF RELATED ACTIVITIES

This activity is related to the strategic information activities to be carried out by University of North

Carolina/MEASURE Evaluation (#7098),NASCOP (#7002), and TE/TBD (#9220).

2.ACTIVITY DESCRIPTION

This activity will strengthen the provincial and district level Health Management Information Systems

(HMIS) currently in use by MOH at health facilities and Community Based Program Activity Reporting

(COBPAR) currently being rolled out at Constituency AIDS Control Committees (CACCS) levels by NACC

through 3 key components. Component 1: Support APHIA II NEP/TBD and MOH program data collection

processes for performance reporting needs (quarterly, semi-annual, annual). This component will support a

participatory, coordinated and efficient data collection, analysis, use and provision of information to track

achievement of APHIA II NEP/TBD and MOH's district level Annual Operation Plan II objectives, and inform

decisions at the local, district and provincial levels, using standardized M&E/HMIS tools approved by the

MOH. Component 2: Strengthen community and facility based reporting systems being rolled out by NACC

and NASCOP. The component will support APHIA II NEP/TBD and MOH to measure progress towards its

contribution to the overall country's Emergency plan, National Health Sector Strategic Plan II and Kenya

National HIV/AIDS Strategic Plan goals and results frameworks. Specific activities will include building

capacity of 15 local organisations and facilities to collect, report, analyse, and use both routine facility and

non-facility data for planning and program improvement. Component 3: Take lead role in coordinating M&E

activities in the province to meet the information needs of USAID/Kenya, the Emergency Plan, MOH, NACC

and other stakeholders, in line with the "three ones" principle. APHIA II NEP/TBD will organize district-level

consensus building forums on M&E issues, distribute standardized data collection and reporting tools,

conduct regular data quality assurance processes at all data generation points, train 35 facility and

community based data point staff on the new data collection/reporting tools and data use for improving

program performance, and hold provincial level quarterly and annual stakeholders' information

dissemination meetings. APHIA II NEP/TBD will be held accountable for tangible results, especially in

increased use of harmonized data collection and reporting tools at health facilities developed by MOH,

increased data use in planning and at dissemination workshops to various stakeholders, increased

supportive-supervisory visits and routine data quality assessments at all data collection points by

M&E/HMIS officers, and improved coordination of M&E activities in North Eastern province. These efforts

should result into demonstrated evidence in increased national level reporting by up to 60% from health

facilities to NASCOP national database.

3.CONTRIBUTIONS TO OVERALL PROGRAM AREA

The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing

to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to fifteen

local organizations/health facilities in strategic information in addition to supporting the training of 35 SI and

program managers in M&E/HMIS, reporting and data use for program management.

4.LINKS TO OTHER ACTIVITIES

This activity is related to the strategic information activity to be carried out by University of North

Carolina/MEASURE Evaluation (#7098), where MEASURE Evaluation will be supporting NACC in rolling

out COBPAR system for community level reporting. It is also related to the strategic information to be

carried out by NASCOP (#7002), where NASCOP will be rolling out Form 726, Form 727 and program

specific client registers for data collection and reporting at health facilities. It is also related to SI TE/TBD

(#9220), that will attempt to investigate the causes for low reporting rate by health facilities and recommend

strategies for achieving 100% reporting level by health facilities.

5.POPULATIONS BEING TARGETED

This activity targets host government and other health care workers like M&E and HMIS officers responsible

for data collection, analysis, reporting and use at both health facilities and community level. Program

managers are as well targeted for orientation on the role M&E program management.

6. EMPHASIS AREAS

The major emphasis area is Health Management Information Systems (HMIS) and minor areas include

Monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.

THIS IS A NEW ACTIVITY.

1. ACTIVITY DESCRIPTION

USAID APHIA II North Eastern Province (NEP) began activities in North Eastern in FY 2007. In FY 2008

APHIA II NEP will work to strengthen the dissemination of key Government of Kenya (GOK) policies and

guidelines, developed at national level, to the district level. In FY 2008 this will include working with the

Ministry of Education and other stakeholders to sensitize teachers about HIV/AIDS prevention and the AIDS

policy for the education sector. In addition, APHIA II NEP will support provincial and district health systems

strengthening by convening consultative meetings and various stakeholders' forums. The activity will target

to reach at least all of the four districts in the province and train at least 40 individuals on HIV-related policy

development.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to strengthening Government of Kenya systems on policy, planning and

budgeting. This will be done by enhancing dissemination and understanding of key government policies

and guidelines, which will be developed or reviewed nationally, out to the districts through provincial

channels.

3. LINKS TO OTHER ACTIVITIES

This activity will link to other APHIA II NEP activities, particularly in AB and OP as well as USAID-OHPS-

HPI-TBD-2008 that will be developing and reviewing key policies and guidelines nationally.

4. POPULATIONS BEING TARGETED

This activity will target teachers through activities guided by the Ministry of Education particularly as regards

the dissemination of the AIDS policy for the education sector.

5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED

The main emphasis area for this activity will be local organization capacity building via serving to enhance

the management and coordination capacity of district and provincial health management teams in all of the

districts in the province served by the implementer.